The Association Between Out-of-Hospital Drug-Assisted Airway Management Approach and Intubation First-Pass Success

Area of Science:

• Emergency Medicine
• Critical Care
• Airway Management

Background:

• First-pass success in endotracheal intubation is a critical metric for emergency medical services (EMS).
• Evidence regarding the impact of various out-of-hospital drug-assisted airway management techniques on first-pass success is limited.
• This study focuses on comparing different drug-assisted approaches without assessing procedural appropriateness or complications.

Purpose of the Study:

• To determine the association between different out-of-hospital drug-assisted airway management approaches and first-pass success during endotracheal intubation.
• To analyze the effectiveness of rapid sequence intubation (RSI), sedation-only, and paralytic-only intubation compared to no-medication approaches.

Main Methods:

• An observational analysis of a large national EMS dataset was conducted.
• Patients undergoing endotracheal intubation during a 911 response, excluding those in cardiac arrest, were included.
• Drug-assisted airway management approaches were categorized based on pre-intubation medications, and adjusted odds ratios were calculated.

Main Results:

• The study identified 12,713 patients; 75.1% achieved first-pass success overall.
• Rapid sequence intubation (RSI) was associated with significantly higher first-pass success (aOR 2.23) compared to no medication.
• Sedation-only intubation showed similar first-pass success (aOR 1.04) to no medication, while paralytic-only intubation also showed higher success (aOR 2.11).

Conclusions:

• Rapid sequence intubation (RSI) use in out-of-hospital endotracheal intubation is associated with increased odds of first-pass success compared to no-medication or sedation-only methods.
• The findings suggest RSI may be a more effective strategy for achieving initial intubation success in the prehospital setting.
• Further research is recommended to explore the relationship between these airway management approaches and patient outcomes or adverse events.